BestLittleGirl - Case - Study

Type responses to questions in the response boxes
The Best Little Girl in the World
Overview
Casey Powell, from The Best Little Girl in the World, is an adolescent
obsessed with losing weight. What began as a diet has turned into slow self-
starvation. Casey has made desperate attempts to gain attention from her
family, fit in as a cheerleader, and become a thin ballet dancer. Her weight
loss eventually did attract her family’s attention—they took Casey to a
doctor, who diagnosed her condition as anorexia nervosa and referred her for
therapy.
Casey continues to lose weight and is hospitalized when her unstable medical
condition becomes life-threatening. You are a nurse working at the hospital in
which she is admitted.
Client Name: Casey Powell

Psychiatric diagnosis: Anorexia Nervosa; Binge-eating/purging type;
Extreme
*For the criteria supporting this diagnosis, please refer to the Diagnostic and
Statistical Manual of Mental Disorders, 5th edition, by the American
Psychiatric Association, and/or your Wolters Kluwer mental-health nursing
textbook.
Date: 10/25/2020
Your name: Jasmine McMorris
Name of the client you are assessing: Casey Powell

Name of the movie: The Best Little Girl in the World
What is the chief complaint? (In the client’s own words, and report of others)
Response: Casey believes that her family wants to “make her fat.” She insists
that she’s just lost a few pounds to be a cheerleader and that she needed to
lose weight for ballet. She thinks she looks okay even though her weight has
dropped from 108 to 83 lbs in a few months. Casey says she “still has some
flab.”
Casey’s parents describe her as “no problem: until the weight loss began. Her
grades were good, she was obedient, and never caused any trouble. Casey’s
father thinks she should “forget about dieting” and go back to the way she
was before her weight loss. Her mother just can’t understand what’s wrong
with Casey or why she’s not eating.
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Based on the above information and a close viewing of the movie, what
questions would you ask during history taking? What are some possible
answers? You might base your questions on the:
 History of the client’s illness.
 Psychosocial history.
 Family dynamics and relationships.
Response:
 “When did Casey begin to have problems? How long has this been
going on? Answer: Casey began school in the fall and several events
contributed to the onset of self-starvation and weight loss; she
compared herself to a model in fashion magazines, her peers were
focused on dieting and thinnes, and she drew uncomfortable remarks
and attention from boys at cheer tryouts and a party.
 “What is Casey’s family like? How do they relate to one another? What
is the environment like?” Answer: the family does not discuss
emotional issues calmly, nor do they engage in effective problem-
solving. Feelings and tension increases until there is a blow, but the
family never discusses problems until the next crisis. The home
environment is rather chaotic. Casey’s father sometimes thwarts her
attempts to assert her independence by making such comment as,
“Don’t talk to your mother.” Casey’s mother is also controlling (she still
chooses all of Casey’s clothes.
What other observations do you have about the client’s behavior?
Response: Casey is withdrawn from her family and friends. She has lost
interest in school and her grades have dropped drastically. She shows signs of
compulsive beahvior, such as putting her clothes in a certain order in the
closet. She weighs herself constantly and makes sexcuses for not eating. She
plays with her food, moving it around the plate but not eating it. She is
preoccupied with food, even cooking breakfast for the family.
In your opinion, is the diagnosis above correct?
Response: Yes.
What requirements does the client meet that support this diagnosis, based on
DSM-5 criteria?
Response: Casey’s weight is less than 85% of what is expected for her age
and height. She has stopped having menstrual periods for several weeks. She
is preoccupied with food and weight loss. She refuses to eat adequate
amounts, and she engages in compensatory behaviors (excessive exercise,
abuse of laxatives, and purging).
What treatment plan would you outline?
Response:Re-establsih normal nutritious eating habits with subsequent

steady weight gain; monitor for risk of self-harm and sucidial ideation;
individual therapy to build social skills, independence, and coping skills;
family therapy to improve conflict resolution and problem-solving skills;
education about anorexia and realistic body image, shape, and size.
With what expected outcomes?
Response: Casey will be free of self-injurious behavior. She will eliminate

compensatory behaviors and will establish normal nutritious eating patterns
sufficient to reach and maintain a healthy body weight.
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Type responses to questions in the response boxes

The Best Little Girl in the World

Client Name: Casey Powell

Your name: Jasmine McMorris

Name of the client you are assessing: Casey Powell

What other observations do you have about the client’s behavior?

In your opinion, is the diagnosis above correct?

What treatment plan would you outline?

Response:Re-establsih normal nutritious eating habits with subsequent

With what expected outcomes?

Response: Casey will be free of self-injurious behavior. She will eliminate

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